Comparative study between Surgical and Endovascular Management of Chronic Iliofemoral Venous Obstruction | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Al-Azhar Medical Journal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article 46, Volume 49, Issue 2, April 2020, Page 849-860 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Document Type: Original Article | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
DOI: 10.21608/amj.2020.94553 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
View on SCiNiTO | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Authors | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abd Elfattah Ali Ismail Ali1; Mohamed yahia zakaria1; Mohamed Abd Elhamed khedr2; Salem Rabae Desoukey Shahen 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1Department of Vascular Surgery, Faculty of Medicine – Al-Azhar University (cairo) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2Department of Clinical Pathology, Faculty of Medicine – Al-Azhar University (cairo) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abstract | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Background: Most of the chronic iliofemoral venous obstructions were managed with low morbidity and no mortality through endovascular intervention which was appropriate for patients with chronic venous obstruction. Endovascular treatment for iliofemoral venous obstruction had progressed rapidly,venous stenting was the primary choice as the stent placement was safe, effective and minimally invasive. However, surgical treatment remains an excellent option in cases in which endovascular techniques had failed or weren’t possible. Objective: The purpose of this study was to review and discuss comparative study between surgical and endovascular procedures in the management of chronic iliofemoral venous obstruction. Patients and Methods: This study included 30 patients (18 females and 12 males) with a ratio of 1.5:1 suffering from chronic ilio-femoral venous obstruction, randomly divided into two equal groups: group (1) for surgical treatment,group (2) for endovascular treatment. Their mean age was 40 years “ranging from 19-83 years” . All patients were belonging to CEAP classifications, C(clinical), E(etiological), A(anatomical) and P(pathological) which included C3 to C6 = clinically state of venous disease in which there was edema up to active venous ulcer. Results: There was no difference between the groups regarding the length of follow up. Iliofemoral venous stenting was safe and effective procedure which could be performed with low morbidity, no mortality, and long-term high patency rate patients for open venous surgery had complication with low patency rate. Conclusion: Endovascular treatmentis the primary treatment for patients with chronic iliofemoral venous obstruction, open surgical treatment should be considered only in cases of unsuccessful or failed endovenous treatment. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Keywords | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Iliofemoral venous obstruction; Surgical; endovascular | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Full Text | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Comparative study between Surgical and Endovascular Management of Chronic Iliofemoral Venous Obstruction Abd Elfattah Ali Ismail Ali1, Mohamed yahia zakaria1, Mohamed Abd Elhamed khedr2 and Salem Rabae Desoukey Shahen1* 1Department of Vascular Surgery, 2Department of Clinical Pathology, Faculty of Medicine – Al-Azhar University (cairo) *Correspondence author details: E-mail: salemshahen01000@yahoo.com
ABSTRACT Background: Most of the chronic iliofemoral venous obstructions were managed with low morbidity and no mortality through endovascular intervention which was appropriate for patients with chronic venous obstruction. Endovascular treatment for iliofemoral venous obstruction had progressed rapidly,venous stenting was the primary choice as the stent placement was safe, effective and minimally invasive. However, surgical treatment remains an excellent option in cases in which endovascular techniques had failed or weren’t possible. Objective: The purpose of this study was to review and discuss comparative study between surgical and endovascular procedures in the management of chronic iliofemoral venous obstruction. Patients and Methods: This study included 30 patients (18 females and 12 males) with a ratio of 1.5:1 suffering from chronic ilio-femoral venous obstruction, randomly divided into two equal groups: group (1) for surgical treatment,group (2) for endovascular treatment. Their mean age was 40 years “ranging from 19-83 years” . All patients were belonging to CEAP classifications, C(clinical), E(etiological), A(anatomical) and P(pathological) which included C3 to C6 = clinically state of venous disease in which there was edema up to active venous ulcer. Results: There was no difference between the groups regarding the length of follow up. Iliofemoral venous stenting was safe and effective procedure which could be performed with low morbidity, no mortality, and long-term high patency rate patients for open venous surgery had complication with low patency rate. Conclusion: Endovascular treatmentis the primary treatment for patients with chronic iliofemoral venous obstruction, open surgical treatment should be considered only in cases of unsuccessful or failed endovenous treatment. Keywords: Iliofemoral venous obstruction,Surgical, endovascular.
INTRODUCTION
RESULTS
Table(1): Number,age and sex distribution.
Patients were categorized according to CEAP classification patients were classified according to degree of clinical presentation where C3 represents about 7 patients (23.3%) , C4 10 patients (33.3%) , C5 2 patients (6.6%) and C6 11 patients (36.6%) respectively (Table 2). Table(2): Percentage of clinical presentation.
Etiology of chronic iliofemoral venous obstruction include history of DVT , Mayturner syndrome, Retroperitoneal fibrosis and pelvic radiotherapy exposure ( Table 3):
Table (3): Etiology of chronic iliofemoral venous obstruction.
A ( CEAP) anatomical distribution of chronic iliofemoral venous obstruction according to location of obstruction to iliofemoral 21 (70%) limbs, iliac 9 limbs( 30%), right limbs 12(40%), and 18(60%) . Occlusive lesions were found in 19 limbs 63.33% and stenotic lesion in 11 limbs 36.67 % , ( occlusive lesions / stenotic lesion 1.7 :1) (Table 4). Table (4): Anatomical site of flow obstruction with nature of obstruction in this study.
Table (5) Comparison between outcome and post operative complications in both endovascular and surgery groups among this study.
DISCUSSION
References
دراسة مقارنه بین إستخدام الجراحة والقسطرة التداخلیة فی علاج الإنسداد المزمن للورید الحرقفی والفخذی
عبدالفتاحعلیإسماعیلعلی -محمدیحیىزکریا -محمدعبدالحمیدخضر -سالمربیعدسوقیشاهین قسمی جراحةالأوعیةالدمویة والباثولوجیا الإکلینیکیة ،کلیةالطب - جامعةالأزهر(القاهرة)
خلفیة البحث: یتم علاج معظم مرضی الإنسداد المزمن للورید الحرقفی والفخذی عن طریق القسطرة التداخلیة مع إنخفاض معدلات الإعتلال وعدم الوفیات . ویتطور علاج الإنسداد المزمن للورید الحرقفی والفخذی سریعاً لتصبح الدعامات الوریدیة هی الخیار الرئیسی حیث أن ترکیب الدعامات یتم بطریقة آمنة وفعالة وأقل تدخلاً.ومع ذلک؛ یعتبر العلاج عن طریق التدخل الجراحى لإنسداد الورید الحرقفى والفخذى هو الإختیار المناسب فى حالة فشل العلاج عن طریق القسطرة التداخلیة. الهدفمن البحث مقارنة بین إستخدام الجراحة والقسطرة التداخلیة فی علاج الإنسداد المزمن للورید الحرقفی والفخذی. المرضىوطرقالبحث : بعد أخذ موافقة لجنة الأخلاقیات الطبیة بجامعة الأزهر، تم إختیار 30 مریضاً من کلا الجنسین؛ وکان متوسط أعمارهم 40 سنة "تتراوح بین 19-83 سنة "، ویعانون من إنسداد وریدی مزمن ، وقسم المرضی عشوائیا إلى مجموعتین متساویتین : مجموعة) 1) للعلاج الجراحی ومجموعة (2) للعلاج بالقسطرة التداخلیة. وقد صنفت المرضی حسب الحالة الإکلینیکیة ابتداء من الدرجة الثالثة إلی السادسة وذلک إبتداء من تورم بالساقین إلی درجة حدوث قرحة وریدیة مزمنة نشطة. نتائجالبحث : لم یکن هناک فرق بین المجموعتین فیما یتعلق بطول المتابعة. العلاج عن طریق إستخدام الدعامات الوریدیة هو إجراء آمن وفعال یمکن إجراؤه مع انخفاض معدلات الإعتلال وعدم الوفیات ، کما تبین أن العلاج عن طریق الجراحة کان له مضاعفات مع إنخفاض معدلات النجاح. الإستنتاج: العلاج عن طریق إستخدام القسطرة التداخلیة هو العلاج الأساسی للمرضى الذین یعانون من الإنسداد المزمن للورید الحرقفی والفخذی ؛ کما أن العلاج عن طریق الجراحة یجب أن یؤخذ فی الإعتبار فقط فی حالات فشل القسطرة التداخلیة .
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Blanch A, Luis M, Marta R and Isabel L. (2014): Study of endovascular treatment of iliofemoral veinous obstruction Journal of Vascular Surgery Venous Disorders, 2 (1) ;2-7.
Garg N, Gloviczki P and Karimi KM. (2011): Factors affecting outcome of open and hybrid reconstructions for nonmalignant obstruction of iliofemoral veins and inferior vena cava. J Vasc Surg., 53:383–393.
Hartung O (2012): Endovascular management of chronic disabling iliocaval obstructive lesions: long-term results. Eur J Vasc Endovasc Surg., 38:118–124.
Ignatyev IM, Pokovsky AV and Gradusov EG. (2017): long-term outcomes of veno-venous bypass operations in post-thrombotic syndrome. J Phlebol Lymphol., 10(1) 5-9.
Jose A. and Peter K. (2019): Rutherford's Vascular Surgery and Endovascular Therapy 9th Edition Chapter 9 Venous Pathophysiology,494.
Joseph D, Raffetto, Robert T and Eberhard T. (2019): Postthrombotic Syndrome, Natural History, Pathophysiology, and Etiology Rutherford's Vascular Surgery and Endovascular Therapy, 9th Edition, Chapter 156 : 6698-6703 .
.
|
Kahn SR, Galanaud JP, Vedantham S and Ginsberg JS. (2016): Guidance for the prevention and treatment of the post-thrombotic syndrome. J Thromb Thrombolysis, 41:144-53.
Kaichuang Ye , Xinwu Lu , Weimin Li , Ying Huang , Xintian Huang , Min Lu and Mier Jiang (2012): Long term outcomes of stent placement for symptomtic Nonthrombotic iliac vein compression lesions in chronic venous disease Journal of Vascular and Interventional Radiology, 23 (4 ) :497-502.
Murphy EH, Johns B, Varney E, Buck W, Jayaraj A and Raju S. (2017): Deep venous thrombosis associated with caval extension of iliac stents. J Vasc Surg Venous Lymphat Disord., 5(1):8– 17.
O'Donnell TF, Passman MA and Marston WA. (2014): Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF). J Vasc Surg., 60(2 suppl) : :3S–59S.
Yves A and Oliver H. (2019): Iliocaval Venous Obstruction: Surgical Treatment In Rutherford’s 8th Edition 61: 929-950.
|
References